Relaxed confocal catadioptric scanning laser ophthalmoscope

ABSTRACT

A number of additional embodiments and optical constructions of a relaxed confocal catadioptric scanning laser ophthalmoscope re disclosed. They improve the functionality of microperimetry, wavefront analysis, Stiles-Crawford measurments, selective therapeutic laser, and the integration of the existing instrument with the capabilities of high speed spectral domain optical coherence tomography (SD-OCT). The improvements pertain to enhanced acousto-optic modulation with regard to rise-time and combination of wavelengths, enhanced control of illuminating beam characteristics and separation of illuminating and returned light within the SLO, enhanced electronic control and options for the galvanometer—polygon combination, additional use of a liquid crystal spatial light modulation, and the modulaties under which SD-OCT can be integrated within the SLO.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is acontinuation of U.S. Pat. Nos. 6,186,628 and 6,789,900. These patents are incorporated in this application by reference.

BACKGROUND—FIELD OF INVENTION

The invention relates generally to instruments for examining and treating the eye and specifically to a scanning laser ophthalmoscope based on a relaxed confocal catadioptric design, in combination with various external light sources, and optimized for advanced non-invasive diagnostic procedures.

BACKGROUND—DESCRIPTION OF PRIOR ART

The ophthalmoscope is well known as an important device for examining the eye, and in particular the retina. As a result of great interest in preserving eyesight, ophthalmoscopes of various constructions have been built. The latest version of the ophthalmoscope, a scanning laser ophthalmoscope, is particularly appealing because of its unique capability of combining a high resolution and high contrast infra-red or angiographic 60 Hz interlaced video imaging of the retina with psychophysical procedures such as microperimetry. A precise correlation between retinal anatomy and retinal functioning can be established with the scanning laser ophthalmoscope. This retinal function mapping that includes information about fixation characteristics, visual acuity and retinal sensitivity, is now known to be very helpful to the surgeon when applying various forms of therapeutic laser and for the purpose of low vision rehabilitation. Van de Velde has disclosed before in U.S. Pat. Nos. 5,892,569, 5,923,399, 5,943,117, 6,186,628 and 6,789,900, which are all herein incorporated by reference, different embodiments of the relaxed confocal scanning laser ophthalmoscope that use various external light sources for therapeutic and diagnostic applications. Such functional extensions of the basic instrument rely to a great extent on its relaxed confocal and catadioptric design, incorporating one or two synchronized avalanche photodetector pathways.

Additional extended functionality has been disclosed in the U.S. Pat. Nos. 5,543,866, 5,568,208 and 6,000,799, herein incorporated by reference. Such embodiments have been constructed and the results have been reported in the following publications, that are herein incorporated by reference:

-   -   1. Frans J. Van de Velde. Quantitative SLO microperimetry for         clinical research in age related maculopathy. In: Noninvasive         assessment of the visual system: from the Topical Meeting Vision         Science and its Applications, Jan. 31-Feb. 3, 1997, Santa Fe, N.         Mex./edited by Dean Yager sponsored by Optical Society of         America; in cooperation with the American Academy of Optometry.         Published/Created: Washington, D.C.: The Society, 1997: 42-47.         ISBN: 1557524718 (Library of Congress).     -   2. Frans J. Van de Velde Role of the scanning laser         ophthalmoscope in photodynamic therapy of macular disease         Publication: Proc. SPIE Vol. 3908, p. 190-201, Ophthalmic         Technologies X; Pascal O. Rol, Karen M. Joos M.D., Fabrice         Manns; Eds. Publication date: June 2000.     -   3. Frans J. Van de Velde. Scanning laser ophthalmoscope         optimized for retinal microphotocoagulation. Publication: Proc.         SPIE Vol. 3564, p. 146-157, Medical Applications of Lasers in         Dermatology, Cardiology, Ophthalmology, and Dentistry II;         Gregory B. Altshuler, Stefan Andersson-Engels, Reginald         Birngruber, Peter Bjerring, Adolf F. Fercher, Herbert J.         Geschwind M.D., Raimund Hibst, Herbert Hoenigsmann, Frederic         Laffitte, Hericus J. Sterenborg; Eds. Publication date: February         1999.     -   4. Frans J. Van de Velde et Al. Scanning laser retinoscopy: a         new technique for evaluating optical properties of the cornea         after refractive surgery Publication: Proc. SPIE Vol. 3192, p.         187-194, Medical Applications of Lasers in Dermatology,         Ophthalmology, Dentistry, and Endoscopy; Gregory B. Altshuler,         Reginald Birngruber, Marco Dal Fante, Raimund Hibst, Herbert         Hoenigsmann, Neville Krasner M.D., Frederic Laffitte; Eds.         Publication date: December 1997.     -   5. Frans J. Van de Velde. Scanning laser ophthalmoscopy:         optimized testing strategies for psychophysics Publication:         Proc. SPIE Vol. 2930, p. 79-90, Lasers in Ophthalmology IV;         Reginald Birngruber, Adolf F. Fercher, Philippe Sourdille M.D.;         Eds. Publication date: December 1996

OBJECT, SUMMARY AND ADVANTAGES OF THE INVENTION

It is the principle object of this invention to disclose a number of additional embodiments and optical constructions of the forementioned relaxed confocal instrument that further improve the functionality of microperimetry, wavefront analysis, Stiles-Crawford measurments, therapeutic laser, and especially the integration of the existing instrument with the capabilities of spectral domain optical coherence tomography (SD-OCT).

In summary, the improvements to the generic relaxed confocal catadioptric instrument, optionally combined with external light sources include:

-   -   1) Improved acousto-optic modulation of the scanning lasers         relating to a sufficiently short rise-time parameter and the         combination of laser wavelengths, resulting in a more efficient         modulation design with better microperimetry, region and         timing-of-interest angiograhy, enhanced suppression of unwanted         light reflexes, and specifically an integration of high-speed         spectral domain OCT.     -   2) An enhanced control of the separation of the illuminating and         detecting light pathways within the SLO permitting control of         the profile and diameter of the scanning beams, with or without         deliberate beam truncation, and enabling the photodetection of         on-axis returned light, useful in many diagnostic applications         that use external light sources.     -   3) Different scanning characteristics of the         galvanometer—polygon combination, permitting the use of a zoom,         similar to the Pomerantzeff-Webb-Hughes design, and specifically         a high intensity background, higher resolution potential acuity         measurement microperimetry, even with a limited RPM value of the         polygon and limited galvanometer capability.     -   4) Alternative Maxwellian view external projection methods,         including the use of a liquid crystal spatial light modulator         (LC-SLM) within a Maxwellian view projection channel for the use         of microperimetry, analogous to a previously described method         for selective PDT or TTT treatment.     -   5) The modalities under which a combination of the relaxed         confocal SLO and SD-OCT becomes feasible, especially with regard         to wavelength interferences, eye-movements and representation of         results at video-rates in near real-time.

Further objects and advantages of the proposed embodiments will become apparent from a consideration of the drawings and ensuing description of a preferred embodiment.

DESCRIPTION OF THE DRAWINGS

FIG. 1 is a diagrammatic representation, illustrating the illuminating pathway of a relaxed confocal scanning laser ophthalmoscope, including the two options for attaching external scanning or non-scanning laser sources. To be noted is the modular composition of the SLO optics. Some modules could be omitted in an otherwise fully functional SLO

FIG. 2 details the return path of the scanning laser light after effectively having been scattered by the retinal tissue.

FIG. 3 details the improved AOM modulation configuration including bean diameter reduction and combination of wavelengths..

FIG. 4 incorporates formulas and data tables per enclosures by reference Melles-Griot and IntraAction, Inc.

FIG. 5 shows the penetration of Gaussian beams into the retina and the relative positioning and size of the confocal aperture for two different FOV.

FIG. 6 demonstrates the difference between pure Gaussian optics and truncation (classic diffractive pattern) in focusing within the human eye (schematic).

FIG. 7 illustrates an alternative embodiment separating several functions such as beam shaping, truncation and multizone coatings of the separating aperture.

FIG. 8 shows a filter wheel combining several options with regard to truncation and reflection characteristics.

FIG. 9 demonstrates the flexibility in controlling the scanning elements polygon and galvanometer. Zoom effects or rasters that are particulary suited for psychophysics are illustrated.

FIG. 10 illustrates the use of a LC-SLM as modifying element in the Maxwellian view projection system. Additional lens modules can be incorporated.

FIG. 11 shows a combination of prior art Van de Velde and prior art Fercher to obtain a function SLO-SD-OCT combination. Multiplexing of the AOMs is provided, as well as coordination of the beam steering control.

REFERENCE NUMERALS IN DRAWINGS

The reference numerals will be adjusted per preliminary amendment to conform to the specification and drawings

DETAILED DESCRIPTION AND OPERATION OF THE IMPROVEMENTS TO THE RELAXED CONFOCAL SCANNING LASER OPHTHALMOSCOPE

A typical embodiment of the relaxed confocal scanning laser ophthalmoscope adaptable for several functional extensions is illustrated in the figures. The principles of scanning laser ophthalmoscopy are described in detail in the prior art (Pomerantzeff, Webb, Hughes, Saban-Cohen et Al., Plesch and Klingbeil). Only the features of the relaxed confocal scanning laser ophthalmoscope that are relevant to the enhancements are further discussed.

I. Enhanced Acousto-Optic Modulation

The use of an acousto-optic modulator to draw a variety of objects in the visible laser raster dates back to the proposals of Hugh and Webb. Before that, a slide or screen was used at a confocal retinal plane to generate psychophysical stimuli. In its simplest embodiment, a typical collimated Gaussian laser beam of about 1 mm diameter traverses the AOM at the well-known Bragg angle. The 1^(st) order diffracted beam is used with about 85% efficiency. Modulation can occur over a dynamic range of several magnitudes. It was quickly noted that if a two laser system was used for separate imaging and psychophysics, the acousto-optical delay time would have to be taken into account, software or hardware wise. Typically this delay is about 50 pixels of each 90 ns duration, i.e. about 0.5 microseconds. Fortunately, this delay turns out to be a stable value. It was also suggested at that time, but never reduced to practice, that a prism could be directly attached to both ends of this AOM in order to combine two or even more wavelengths, presumbly at their optimal Bragg angle.

Two problems have been observed by the author with regard to the above. First, detailed psychophysics requires a much higher bandwith of modulation in order to correctly and evenly represent the correct light intensity of even single pixel objects. This is particularly clear in the case of the smallest acuity targets (about 1.5 minarc on the retina) that are possible within the laser raster. The second problems relates to the prism. From the Bragg formula it can be seen that shorter wavelengths require a smaller Bragg angle and vice-versa upon entering the AOM. A prism however will cause the shorter wavelength to have a larger Bragg angle and could therefore not be used as previously illustrated. Both problems can actually be solved at the same time with an appropriate optical construction.

In order to decrease the rise-time for modulating the traversing laser beam, it is necessary to focus and collimate the orginal 1 mm beam to a size that is approximately 0.2 mm. In order to accomplish this, the AOM has to be driven at a higher frequency, 80 Mhz at a minimum. To reduce this beam diameter a Gallilean collimator can be used. If this collimating telescopic lens system is used after the prism, then the divergence of wavelengths is switched and corresponds to the correct configuration to enter the AOM. Actual prism values to be used and lens distances to be observed depend on the refractive index of the prism glass, desired Bragg angles and power of the telescope, but are readily calculated from tables provided by Melles-Griot. Also, the prismatic effect itself can be obtained by entering the collimator off-axis on one side and appropriately angulating the second element of the collimator.

At the other end of the AOM, a similar prism and beam expander will realign the different wavelength laserbeams and provide the required beam diameter. In view of what will follow, it is not unusual to obtain a fairly large beam diameter, larger than 1 mm, suitable for truncation at some further point in the illuminating pathway.

It is also understood that the prisms are not necessary if only one wavelength is used for which a short rise time is desired. Rise-times in the order of 30 ns, which are definitely subpixel, are not difficult to obtain and compare favorably with the current rise-times of about 200 ns (beyond two pixels)

If both IR and visible wavelengths are equipped with appropriate AOMs, then a large number of possibilities exist with regard to multiplexing time or area wise areas of interest for various wavelengths. For example, the neighborhood of a therapeutic laser spot could be illuminated with blue or green to better visualize or measure the change in backscatter through the retinal pigment epithelium during (micro)photocoagulation. Many other similar applications can be envisaged. The capability of spatially or temporally modulation over a large dynamic range of several wavelengths and relating this under one CPU—multilayer graphics control card is one of the biggest assets of scanning laser ophthalmoscopy. Currently it allows multiplexing to avoid the need of synchronized detector pathways.

When passing different wavelengths through one AOM is should be noted that the RF efficiency is related to wavelength, even at the correct Bragg angle for each wavelength. The manuals and specification sheets with formulas of Intraaction Inc. AOM models E801D680 Mhz driver and ATM-80A1 are herein incorporated by reference. For refractive index values of different Schott type glasses such as BK-7, and the specifications of dispersing prisms we incorporate the tabular data of Melle-Griot catalogue, copyright 2002.

II. Enhanced Aperture for Separting Light Pathways Inside the SLO

Every ophthalmoscope since its conception needs to separate at one point the illuminating pathway from the pathway that is followed by the returned light. Obviously because the illuminating source and the observer's eye (or detector) cannot be in the same place, but perhaps more pertinent to understand, the need to avoid strong reflexes from mostly the anterior surface of the cornea. This can be accomplished in two ways. A central stop or aperture is used to separate both pathways. Conveniently the aperture's size and location are such that all of the spurious reflexes are transmitted or stopped by the same stop or aperture (essentially returning to the light source itself). This mechanism is found traditionally in ophthalmoscopes and flndus cameras of all sorts. Confocal (scanning) microscopes use the fact that if the detector is confocal with the object, reflexes coming from other layers would arrive at this detector much diluted and would therefore not contribute signifcantly to an undesirable contrast reduction. Although this principle, thus solely using a beamsplitter, alone could be used in a confocal SLO to accomplish this, the relaxed confocal design of the SLO—which means that the confocal aperture is at least four times laser in diameter than the illuminating laser spot on the retina—would render this mechanism inadequate. Only a tighly confocal instrument could therefore use a beamsplitter to this effect.

As a result, the separating aperture in the relaxed confocal SLO is wholly transparent. Under the current invention we propose to provide a series of apertures, e.g. placed on a larger rotating wheel to be able to select one at will, with the following characteristics:

-   (1) The (Gaussian) illuminating laser beams in the SLO can be     truncated at this point to different diameters and even an     elliptical shape. On a side, such elliptical beam shaping can also     occur just prior to the aperture with the help of cylindrical lenses     or more appropriately anamorphic prisms. Truncation of the Gaussian     beams allows a more diffraction limited spot to focus onto the     retina because instead of the Gaussian beam formulas, the classic     diffraction limited aperture formula will be applicable. With other     words, if the initial beam diameter is 3 mm Gaussian, it can be     stopped down by the aperture to 1 mm, be far more even in     illumination and result in a substantially smaller spot on the     retina than if a 1 mm Gaussian beam diameter was used. -   (2) The aperture itself can consist of clear glass that is coated in     such way that different wavelengths, e.g. imaging vs psychophysics     wavelength can have a different beam diameter, but still be     collimated beyond the aperture. To summarize this point, a variable     aperture can control the diameter (and shape) of the focused spot on     the retina. Thereby the need for complex collimator-telescopes is     avoided in the illuminating pathway. -   (3) The aperture can be coated on the side facing the returning     light to specifically return to the detectors valuable diagnostic     light coming from the retina that would otherwise pass through the     opening. This is particularly the case for laser light from external     light sources attached to the SLO in a manner already desribed. E.g.     to measure the directionallity of the photoreceptors, the waveguided     light inside the photoreceptors will be reflected back along the     same path (and not be multiply scattered). To collect this light     efficiently, such aperture is highly advantageous. It is possible to     conceive of situations where the illuminating laser light from the     SLO itself needs to be retrieved. What about the spurious     reflections in this case? It has been clarified before that the     reflexes occur practically exclusively when the illuminating     scanning laser reaches the apex of the cornea (otherwise it is     reflected off to the side), or in an special single situation where     at all angles the illuminating laser is more or less perpendicular     to the corneal surface. We simply avoid this position and to     eliminate the corneal reflex, we can acousto-optically modulate the     sources whether external or internal to be off for this position.

As a minor remark, we would like to draw the attention to the fact that the confocal detecting apertures also come in different diameters, with a central stop, and coatings. It is even possible to create assymetric apertures to emulate indirect lighting from one side. After years of experience, we do believe that a variety of direct confocal apertures are sufficient for diagnostic purposes. In the above paragraphs we proposed to do something similar to the other critical aperture in the SLO optics.

With regard to the illustrations we incorporte by reference the Melles-Griot catalogue optics information on truncation of Gaussian beams, copyright 2002.

III. Enhanced Electro-Optical Control of the Galvanometer-Polygon Scanning Elements

Very early co-pupillary SLO designs by Pomerantzeff and Webb used two mirror-galvanometers in tandem to obtain the desired scanning laser raster. Remarkable at that time was the flexibility of the laser raster dimensions by simply varying the amplitude and frequencies of these galvanometers. Later confocal SLO models adhered closely to the universal NTSC or PAL standards for generating the raster. Also, the speedier polygon was introduced for the fast horizontal scanning. Typically, the polygon would run at about 40,000 RPM and would have either 24 or 25 facets to create the horizontal raster lines. The vertical scanning is typically 50 or 60 Hz interlaced. Interlacing has a long history dating back to the origin of TV. It exists to conserve bandwith and to cope with psychophysical flicker that would otherwise be visible to the observer. Zooming in such an SLO is typically accomplished with the help of a Campini type of telescope-invertor. It conveniently changes the horizontal angle of deflection between two values, and also at the same time adjust the beam diameter of the illuminating lasers. Such constellation is seen in the accompanying FIGS. 1 and 2.

At present, there is a tendency to digitally create and control both video in and out for the SLO, and one result is that video standards have become more flexible with regard to refresh rate and pixel dimensions. The SLO can take advantage of this by electronically adjusting the polygon and galvanometer characteristics, rather than by inserting additional optical elements. This would render the instrument even more compact and economical. As will be explained, the previously mentioned capability of beam truncation is important in this respect. It is quite important to understand that the laser raster characteristics or requirements are different for pure imaging or psychophysical purposes. This will be explained below.

One known formula is basic to our discussion: it describes the relation between the number of image lines (raster lines), including any number of “virtual” lines drawn during the vertical retrace, the number of facets on the polygon, the polygon speed and the refresh rate of the raster that is determined by the galvanometer. The formula is thus: Refresh Frequency X # of lines=# of facets X RPM of polygon. This is applicable to both interlaced or non-interlaced schemes. Note that the angular amplitude of the galvanometer and the actual beam diameter of the flying spot on the retina do not appear in this formula. Those last two parameters are to be independently controlled. By varying the above mentioned parameters the following results can be obtained:

-   (1) in a generic SLO, using the NTSC standard, the interlaced video     is 30 Hz for 525 “TV lines. The A/D converter transforms the image     into a 640 by 480 “square” pixel format. The number of facets is 25.     Optimally the number of facets is a real number fraction of the     total number of lines to ensure that the same facet always draws the     same line in the raster. Otherwise, small discrepancies (wobble) in     facet orientation may cause noise or ripple in the image. Current     polygons suffer much less from this problem. The resultant RPM for     this embodiment is therefore 30×525 divided by 25, i.e. 630 rounds     per second or usually expressed as 37,800 RPM. This speed is kept     constant through a PLL crystal driven servo mechanism. A trigger is     derived as a master clock signal from each turning facet in a matter     described before. Because we control extremely well the timing, the     precise temporal resolution of the image has been used before to     obtain an excellent spatial resolution for wavefront analysis     purposes. -   (2) The second possibility is reminiscent of the original zoom     mechanism that was implemented by Pomerantzeff et Al. in their first     co-pupillary SLOs. The same A/D conversion is used but the polygon     slows down by a factor of 2 (or more generally x), the frequency of     the galvanometer is reduced by 4 (or generally xˆ2), thus, in     combination, the number of horizontal lines that are drawn will     double (or increase x fold). The formula still holds and the number     of facets obviously remains the same.

Typically for imaging purposes, the spot diameter on the retina will not change. Although this may seem rather strange, it should be observed that the light being collected is more determined from the size of the confocal aperture than from the initial impact zone on the retina. This means that basically the same image area on the retina will be visualized, for example a 40 degree diagonal FOV, regardless of zoom, but the magnification factor changes, i.e. the number of horizontal and vertical pixels. The price that is paid for a lower resolution is “subsampling” of the same area on the retina, the bonus we get is increased refresh rate. This increase in refresh rate (or decrease) has some implications in the presence of eye movements and has a very important impact on psychophysical applications because of the human eye's sensitivity to flicker under certain conditions. Three types of fixational eye movements exist that merrit our attention: a very fast 60 Hz, small amplitude oscillation that is generally below the resolution of a regular SLO (not adaptive optics SLO). A second movement is a slow drifting of typically 1 degree per second. In general this will only cause a slight distortion of the consecutive images even at low refresh rates. For the purpose of fiducial landmark tracking, these movements will not affect close TV lines but might lines that are spaced at the edges of the screen. A third type of eye movement are the “corrective” micro saccades” or flicks. They are a rapid restoration of the line of sight onto the object of fixation. Such flicks will either case a clearly visible abrupt shift in the image, visible as a break or discontinuation of the vessel pattern upon freezing the image or they will cause the same fiducial landmarks to be appreciably separated from each other in consecutive images. During active tracking using e.g. two-dimensional normalized gray-scale correlation these flicks can be distinguished from the slower drifting based on aforementioned characteristics. Because of this and because of the typical distortion of the laser raster, fiducial landmarks for tracking should be chosen as close as possible to the area of interest to be tracked.

-   (3) Another problem occurs when we not only image the retina, but     perform psychophysics in a manner that has been described before     using relatively low intensity visible laser wavelengths and     acousto-optic modulation. From psychophysics we know that only a low     visible background intensity, and fairly small spot sizes will have     a chance to be not affected by a 30 Hz refresh rate, those     backgrounds will typically be 100 trolands or less. SLOs that use     interlaced video at 60 Hz can use a large bright background with     dark stimuli e.g. to measure visual acuity. How can we solve this     problem if the polygon speed cannot be further increased or the     galvanometer has reached its limitations with regard to refresh     frequency given a certain mirror load and angular amplitude? This     situation can be addressed as thus: in the basic formula we double     the frequence of update, we divide the number of lines by 4 and     reduce the RPM of the polygon by a factor of 2. Therefore     horizontally we get indeed a doubling of the number of pixels. At     the same time the angular amplitude of the galvanometer is cut in     half as well. Most galvanometers can indeed trade amplitude for     refresh rate to some extent given a certain mirror load. In summary,     we obtain a 60 Hz non-interlaced display of 120 lines over the full     available width of the raster at increased (double) resolution: this     is an advantageous situation for text display and acuity testing.     Typically, the spot size on the retina of the visible laser should     be appropriate to cause the pixels to fill up smoothly with no     overlap or any appreciable “empty” space between the raster lines.     As mentionend before, this smaller size can be used if less     magnification is used for imaging purposes, but would be problematic     in the case of psychophysics. In that situation, the spot size could     be adjusted through aperture and beamshaping control of the laser     that is responsible for the visible light (adjustable beam     truncation).

Adjustment of the angular vertical amplitude of the laser raster with the galvanometer is useful in other situations: e.g. to calibrate square pixels and if the lines are made to overlap, a higher resolution can be obtained when confocally detecting the position of the laser spots projected by the previously mentioned external wavefront measurement module.

IV. Interfacing with External Light Sources for Various Purposes, Requiring Spatial Light Modulation

Some embodiments have been described in the referenced patents. For example, the use of a wavefront measurement module and selective PDT or TTT laser treatment to the retina. Both applications are different in some respects: PDT or TTT requires a fairly large amount of power to be delivered to the retina, hence the use of a higher powered multimode laser and a simple mode scrambling device. The spatial pattern that is desired is most often stationary and requires only some adjustment in positioning if the retina were to move. The laser light is delivered in Maxwellian view mode.

The wavefront module essentially requires parallel pencils of light to cover systematically the pupillary area. Because those (thick) rays are parallel they are supposed to focus on the same spot on the retina in the absence of refraction anomalies. If a low power laser source is used to generate the pencils, the laser could first be focused to a very small spot onto a thin diffuser. On the other side of the diffuser a pinhole is attached from which the light will fan out, its coherence being broken. Divergence can be controlled if necessary with a negative lens. The N.A. can be fixed with a subsequent large aperture (about 10 mm) and collimation will prepare the bundle of light to hit the LC-SLM. Several adjacent pixels would let an approximately 1 mm beam travel towards the pupil. It is possible to use phase retardation LC-SLM for nulling procedures. In this case the orientation of the ray would be slightly adjustment to create a spot on the retina that is coincident with a reference spot.

Using the Mazwellian view projection of the TTT method and the LC-SLM described above, it is straightforward to project microperitric stimuli onto to the retina. Additional modules comprising two lenses, can be inserted in the optical pathway to take care of magnification or focus issues (these extra modules have been omitted from the drawings). For further reference with include by reference a paper presented at the International Conference on Lasers '96, Society of Optical and Quantum Electronics, 2-6 December 1996, entitled “Applications of programmable spatial light modulators”, and selected references, by author Michael K. Giles.

V. Interfacing with Fast Scanning External Light Sources for Diagnostic or Therapeutic Purposes

The electro-optical characteristics of the relaxed confocal scanning laser ophthalmoscope can be used to great benefit when combining this instrument with external laser sources, in particular scanning laser sources. Several examples of increasing complexity have been outined in the incorporated patents by reference. We would like to give an overview and describe an additional possibility below.

For therapeutic purposes there has been an increasing interest in targetting selectively the retinal pigment epithelium (Although we could argue that preferably the photoreceptor outer segments should be disabled in a certain pattern or holes created within an obstructive and thickened Bruch's membrane). The technique has been referred to as microphotocoagulation. In brief, scanning is performed with the help of a two dimensional or one-dimensional acousto-optic deflector. The details have been outlined in U.S. Pat. No. 6,789,900.

There is also another important diagnostic application of scanning external light sources based on the integration of spectral domain optical coherence tomograhy (SD-OCT) into the SLO based on some general principles outlined before and taking into account some particular observations with regard to the use of SD-OCT itself.

In brief, SD-OCT was conceived by Fercher in 1995 as an alternative to the classic time domain OCT. This time domain OCT requires a lay-out that is similar to a Michelson interferometer to record reflections within the retina (Thus exploring the retina in depth or z-direction; the SLO typical explores the x-y plane and sort of integrates the information from the z direction). The time domain OCT requires a reference arm that rapidly scans back and forth. This is fairly time consuming. Using broadband light sources, this interference method can obtain a resolution in the z-direction of as little as 5 micron. This compares very favorably with the limited z-resolution of a confocal SLO which is at best about 150 micron. Thus both diagnostic techniques are very complimentary and their combination would give rise to an instrument in which the ophthalmologist has an immediate overview of the retina and where he would be able to obtain a section of histologic quality (much like a slitlamp would do) between any two points of interest.

Up to now such combinations exist, combining a variation of a classic findus camera with time domain OCT. However several disadvantages exist: the time domain is slow, about 400 samples can be taken per secon, several thousand are needed to collect a reasonable amount of information. In this time interval, eye movements occur and also, the fundus visualization is either non-confocal IR which does not permit viewing details on the retina, or it is a color reference picture on which it is difficult to outline precisely where the OCT samples have been taken.

Some of these problems have been resolved by construction an SLO-OCT combination (Podoleanu) that uses the x-y scanning lasers to obtain the interference data as it scans along a raster pattern on the retina (C-plane scanning). This however does not resolve some of the issues regarding speed, S/N ration and immunity against eye movements, since the technique is still essentially within the time domain.

Our SLO-OCT combination is based on the spectral domain method and exploits the unique capabilities to combine scanning laser sources as described in referenced patents. Only recently has SD-OCT become mainstream (in combination with a classic slitlamp or fundus camera) because of the intense calculations (Fourier transforms) that have to be performed. Curent computational devices are upt to this task and it is not unusual to be able to derive 40,000 samples per second. It is precisely this high speed acquisition of information that makes integration within the SLO possible. Besides the general issues that have been addressed in previous patents and for which the solutions are here applicable by comparision, two special considerations have to be made:

-   (1) SD-OCT using a broad-band light source, e.g. in the     near-infrared region with subsequent spectral analysis of the     returned light that was subject to interference. The SLO typically     and for ease of implentation also uses near-infrared light. We want     to preserve our near-real time capability of observing the retina     (and eye movements) and have a near-real time histologic sectioning     as well: the answer to this problem lies in multiplexing of the two     information channels (SLO and OCT). For this purpose, the CPU unit     does know the coordinates and timing of the OCT sampling. This     computer also controls the modulation of the IR laser source (and     any visible laser sources) within the SLO for x-y scanning. Such     modulation whether TTL based or AOM based, is flexible enough to     permit both the SLO and OCT to gather information with minimal delay     or near-realtime without interfering with each other. -   (2) Along the same lines it can be understood that active two     dimensional normalized gray-scale correlation tracking of fludus     landmarks in the vicinity of the histologic section is possible at     video-rates.

The two systems (SD-OCT and relaxed confocal SLO) can be combined optically using similar constructions as described in previous patents. Ideally, the scanning of the OCT component happens to originate from a pivot point and through the similar pivot point of the SLO scanning lasers. The module can be completely external, or it can still make use of the main reflecting mirror inside the SLO. In the later case, the pivoting mechanism is smaller and consist of a mirror that is allowed to move in x-y directions on top of a ball bearing. Focussing however requires at least one more lens element.

At this point it is useful to remind that fast IR modulation (TTL or AOM based) can have an additional application in video blanking for microperimetry purposes: when measuring absolute thresholds on the retina; even “invisible” IR light of 800 nm still retains the capability of stimulation the retina: the IR laser could then be turned of in the neighborhood of the stimulus. Also multiplexing in the case of combined ICG and fluorescein angiography, and multiplexing in general when only one detector pathway instead of two are available, are important applications of fast IR modulation.

As a last remark we point to the development of polarization sensitive OCT techniques: these would have the capability of analysing the state of polarization, hence birefringence of the nerve fiber layer in the retina based on an absolute high resolution space interval (typically 3 micron). This cannot be realized with the current polarization sensitive SLOs that suffer from the interference of corneal birefringence, measure the total birefringence in toto of the nerve fiber layer. Such technique cannot readily distinguish between true nerve fiber layer thinning and molecular changes (microtubules) within the nerve fiber axons that eg. limit axonal transport in the early stages of neuro-degenerative diseases such as glaucoma and Alzheimer's.

For further information on SD-OCT we include by reference the following U.S. Pat. No. 6,3777,349 by Adolf Fercher, and the following publications: (1) Measurement of intraocular distances by backscattering spectral interferometry, optics communications, by A. Fercher et Al, 1995; (2) Optical Coherence Tomography Journal of biomedical optics, vol 1(2) pp 157-173 1995 by A. Fercher; (3) Optical coherence with spectral radar by M. Bail et Al. Photon Propagation in Tissues II Proc. SPIE vol 2925 page 298-303, 1996.

SUMMARY

Additional embodiments of the relaxed confocal scanning laser ophthalmoscope have been disclosed that relate to:

-   -   (1) improved modulation of visible and IR lasers, with regard to         optical rise-time and combination of wavelengths;     -   (2) aperture controlled truncation of the illuminating laser         beams and coating of such aperture to preferentially reflect         on-axis returned light to the detectors of the SLO.     -   (3) Variations on the basic scanning formula Freq×lines=number         of facet×RPM, whereby complications of a low refresh rate and         resolution are avoided for certain psychophysical tests.     -   (4) Alternative use of a liquid crystal spatial light modulator         for microperimetric purposes     -   (5) Combination of the SLO with fast scanning external light         sources, in particular the light sources that are employed in         spectral domain optical coherence reflectometry or tomography.

Although the descriptions above contain many specifications, these should not be construed as limiting the scope of the invention but as merely providing an illustration of the presently preferred embodiments. Other embodiments including additions, subtractions, deletions, or modifications will be obvious to those skilled in the art and are within the scope of the following claims. The scope of the disclosure should be determined by the appended claims and their legal equivalents, rather than by the examples given. 

1. A scanning laser ophthalmoscope capable of modulating scanning laser sources said modulating means comprising: A. an acousto-optic modulator; B. collimating lenses; C. focusing lenses; said focusing lenses and said collimating lenses capable of reducing the beam diameter of a traversing laser beam of a certain wavelength lambda (1) at the optimal Bragg angle for said wavelength lamda (1), said beam diameter small enough to permit said acousto-optic modulator to change the first-order output of said laserbeam within a time of less than one pixel duration.
 2. The modulating means of claim 1 further comprising the improvement of a prism; said prism having appropriate wedge angle and refractive index to disperse a traversing laser beam of a wavelength lambda (2) at the optimal Bragg angle for said wavelength lambda (1) while at the same time preserving the optimal Bragg angle for said wavelength lambda (1).
 3. A scanning laser ophthalmoscope comprising aperture means, said aperture capable of tuuncating at least one laser beam after traversing said modulating means and before reaching the scanning elements of said scanning laser ophthlmoscope.
 4. A scanning laser ophthalmoscope comprising aperture means of claim 3, whereby said transparent aperture means is coated to reflect light of wavelength lambda (3) coming from the eye and to let pass light of said wavelength lambda (1) and said wavelength lambda (2).
 5. A scanning laser ophthalmoscope comprising: A. Galvanometer scanning means; B. Polygon scanning means; C. Electrical circuitry means for controlling parameters from the group of speed of polygon, amplitude of Galvanometer, frequency of galvanometer; said electical circuitry causing a number of lines to be drawn in the laser raster corresponding to the formula Freq×number of lines=number of facets polygon×speed of polygon; and said electrical circuitry having the capability of changing multiple said parameters consistent to said formula.
 6. A scanning laser ophthalmoscope with additional channel for projecting Maxwellian view grahical pattern on the retina of the eye, said projecting means comprising liquid crystal based spatial light modulator.
 7. A scanning laser ophthalmoscope further comprising the improvement of: A. infrared modulating means; B. spectral domain optical coherence based device comprising spectral grating, broadband light source, detector. C. electro-optical means to connect said spectral domain optical coherence based device to said scanning laser ophthalmoscope. 